Citation Nr: 0002522 Decision Date: 02/01/00 Archive Date: 02/10/00 DOCKET NO. 98-03 590A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Wilmington, Delaware THE ISSUES 1. Entitlement to service connection for dengue fever. 2. Entitlement to service connection for a skin disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Hickey, Counsel INTRODUCTION The veteran had active service from November 1942 to December 1945. This appeal to the Board of Veterans' Appeals (Board) arises from the September 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for residuals of dengue fever and for a skin disorder, as well as service connection for hearing loss. By a rating action in September 1999 service connection was granted for hearing loss. Accordingly, that issue is no longer in appellate status. FINDINGS OF FACT 1. The record does not include competent medical evidence in support of the claim for service connection for dengue fever; the claim is not plausible. 2. The record does not include competent medical evidence in support of the claim for service connection for a skin disability; the claim is not plausible. CONCLUSIONS OF LAW 1. The veteran has not submitted a well-grounded claim for service connection for dengue fever. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 2. The veteran has not submitted a well-grounded claim for service connection for a skin disability. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background Service medical records are negative for complaints, findings, or diagnosis related to dengue fever, or a skin disorder. According to notations in the service medical records dated in May 1943, the veteran underwent a tonsillectomy. The report of the veteran's December 1945 physical examination for separation from service reflects normal condition of the skin. According to the report of an April 1998 VA examination for skin disease, the veteran complained of chronic rash on the right hand and both feet since 1945. Objective examination disclosed that the right hand was erythematous and cracked. The nails of the right hand were dystrophic, thickened, and raised from the nail bed. The condition of the feet was described as dry, mildly erythematous. The left big toenail was discolored. The diagnoses were tinea pedis and onychomycosis. The report of an April 1998 VA examination for ear disease reflects that evaluation of the auricle revealed seborrhea, bilateral fossa transcutaneous. On VA examination conducted in September 1998 the veteran gave a history of malaria in 1943. His symptoms included sweating and chills, and he was reportedly treated with quinine. Since that time the veteran said he had felt weak and tired with discomfort in his legs. Over the years he had also noted temperature elevation from time to time which he believed was due to his previous exposure to malaria. The veteran further reported that he had never been in a hospital or diagnosed with malaria. On physical examination skin rashes, discharges and abnormal, pigmented lesions were absent. It was recorded that there was no evidence of swelling in the lower extremities. The diagnoses were: 1. malaria by history, status post appropriate treatment; 2. tiredness and weakness, no history of reexposure to malaria; no history of a diagnosis of malaria since the prior exposure. Under the heading of specific evaluation information reference malaria, the examiner listed the following: 1. The veteran had malaria. 2. The veteran was treated appropriately in the service. 3. The veteran did not have any recurrences which were compatible with malaria. 4. The veteran was never diagnosed with malaria. 5. No further evaluation is required. No further testing is required at the present time. 6. The veteran did not provide a history of dengue fever. No further evaluation is required for dengue fever. When the veteran testified at his personal hearing in March 1998 he related that he was one of a group of marines who became ill at the same time during service. He attributed the condition to mosquito bites. The veteran said they were taken to a "hospital part of a ship" where they were treated by corpsmen for symptoms which included fever, sweating, and being "covered in bumps." The veteran testified that he was told he had a case of "malaria or dengue fever or something like that." The veteran also reported that subsequently, while serving in the South Pacific, he contracted a fungus affecting his fingers, including the nails, and also the bottoms of his feet. Still later he reportedly was treated for a bad episode of fungus affecting his penis while stationed on Guam. At the time of the hearing, the veteran's skin disorder caused his hand to hurt when he held onto anything. His representative stated that the hand appeared irritated and red. The veteran's finger nails also appeared brittle and half white according to the representative. The veteran related that over the years he had treated his skin symptoms with nonprescription products. In response to questioning he said that no doctor had ever told him what type of skin condition caused his foot and hand symptoms. Currently he used two medications to treat the problem. He said that after returning from service overseas he was initially ill for two or three weeks, with symptoms similar to those in service, fever, sweating and fatigue. He also reported recurrences of fever and chills related to weather changes up to the present time. He did not obtain medical attention for these symptoms, essentially because the VA hospital was too crowded and he could not afford private treatment. Once a year the veteran had served as a blood donor until he reached the age limit. Entitlement to Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). The threshold question to be answered is whether the veteran has met his burden of submitting evidence sufficient to justify a belief that his claim for service connection is well grounded. In order for him to meet this burden, the claimant must submit evidence sufficient to justify a belief that his claims are plausible. 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet.App. 78 (1990). A plausible or well grounded claim for service connection requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in- service injury or disease and the current disability (medical evidence). Epps v. Gober, 126 F.3d 1464, 1468 (1997); Caluza v. Brown, 7 Vet.App. 498 (1995). Where the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required to fulfill the well-grounded claim requirement of 38 U.S.C.A. § 5107(a). Lathan v. Brown, 7 Vet.App. 359 (1995). Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). In determining whether a claim is well-grounded, the supporting evidence is presumed to be true and is not subject to weighing. King v. Brown, 5 Vet.App. 19, 21 (1993). In regard to establishing a well-grounded claim, the second and third Epps and Caluza elements (incurrence and nexus evidence) can also be satisfied under 38 C.F.R. § 3.303(b) (1999) by (1) evidence that a condition was "noted" during service or during an applicable presumption period; (2) evidence showing post service continuity of symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology. Savage, 10 Vet. App. at 496. Moreover, a condition "noted during service" does not require any type of special or written documentation, such as being recorded in an examination report, either contemporaneous to service or otherwise, for purposes of showing that the condition was observed during service or during the presumption period. Id. at 496-97. However, medical evidence of noting is required to demonstrate a relationship between the present disability and the demonstrated continuity of symptomatology unless such a relationship is one as to which a lay person's observation is competent. Id. at 497. The veteran claims entitlement to service connection for dengue fever. Although his testimony is sufficient evidence of disease during service, and of recurrent similar symptoms, for purposes of determining well-groundedness, the veteran has presented no competent medical evidence of a current diagnosis which is medically linked to the claimed continuity of symptomatology and the reported disease in service. Although evidentiary assertions by the veteran must be accepted as true for the purposes of determining whether a claim is well-grounded, the exception to this principle is where the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion. King v. Brown, 5 Vet.App. 19, 21 (1993). The veteran, who is not a medical professional is not competent to provide evidence of medical causation or diagnosis. See, Moray v. Brown, 5 Vet.App. 211 (1993); Grottveit v. Brown, 5 Vet.App. 91 (1993); Espiritu v. Derwinski, 2 Vet.App. 492 (1992). In the absence of support from competent medical evidence the claim for service connection for dengue fever is not plausible and must be denied as not well-grounded. With regard to the claim for service connection for a skin disability the record reflects the first element of a plausible claim, current medical diagnoses of tinea pedis and onychomycosis. Although the veteran's lay reports satisfy the requirement of evidence of disease during service, and a reported continuity of symptomatology, for purposes of wellgroundedness, the record is devoid of the requisite medical evidence to show a nexus between the currently diagnosed disorders and the reported symptoms during and since service. In the absence of competent evidence of the third element of a plausible claim, the veteran's claim for service connection for a skin disability also is not well- grounded. ORDER The claims for service connection for dengue fever and a skin disability are denied as not well-grounded. G. H. SHUFELT Member, Board of Veterans' Appeals